What is mental health parity?

Mental health parity describes the equal approach to mental health and standard medical treatments. In other words, under mental health parity an insurance plan cannot make coverage for a mental health disorder like schizophrenia more difficult or more expensive to obtain than other medical or surgical treatments like heart disease.

Most health plans are required to follow federal mental health parity laws,

including employer-sponsored, individual policies and certain Medicaid health plans. These insurance plans have to guarantee that the following are applied equally to mental health services:

copays
coinsurance
out-of-pocket maximums
limits on the number of and length of covered inpatient/outpatient visits
out-of-network coverage
medical necessity criteria
(which is used to determine whether treatment will be paid for by insurance)

For example, a health plan would not meet parity requirements if the length of inpatient visits covered by insurance were shorter for a patient’s schizophrenia than their heart condition. Nor could a health plan charge higher copays for mental health services than for medical services.

What is mental health parity?

Most health plans are required to follow federal mental health parity laws, including employer-sponsored, individual policies and certain Medicaid health plans. These insurance plans have to guarantee that the following are applied equally to mental health services:

copays
coinsurance
out-of-pocket maximums
limits on the number of and length of covered inpatient/outpatient visits
out-of-network coverage
medical necessity criteria
(which is used to determine whether treatment will be paid for by insurance)

Test your knowledge

Mental health parity applies to all health plans.

Correct!

Most mental health plans are required to follow federal mental health parity laws. However, parity laws only apply to health plans that provide mental health and substance use benefits. Notable exceptions to the laws include Medicare, some Medicaid plans, and retiree plans.

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Why does mental health parity matter to Minnesotans?

One in four adults experiences a mental illness in his or her lifetime regardless of age, race, religion or income.There is no bigger public health issue facing Minnesota communities than mental health.

In every corner of the state, hospitals, community partners and law enforcement cannot meet the demand for mental health services. Yet, an overwhelming majority of Minnesotans remain unaware that many health insurers are required to provide equal coverage for mental health, behavioral health and substance-use disorders.

Minnesota’s hospitals believe every Minnesotan deserves access to the mental health care they need, delivered in the right setting. Mental illnesses are treatable health conditions, and they should be treated with the same urgency as other medical conditions, like diabetes or heart disease. Federal and state mental health parity laws strive to enshrine a fundamental Minnesotan value: Discrimination is wrong.

Why does mental health parity matter to Minnesotans?

Test your knowledge

Your insurance plan must require equal co-pays for a visit to a cardiologist and a visit to a psychologist.

Correct!

As long as your plan is required to follow federal parity guidelines (as most are), you should never be charged a higher co-pay for mental health care than other types of health care.

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As long as your plan is required to follow federal parity guidelines (as most are), you should never be charged a higher co-pay for mental health care than other types of health care.

Here are some signs your health plan may be violating parity laws:

You have difficulty finding mental health providers or psychiatrists within your insurance plan network.

Higher costs or fewer visits for mental health services than for other kinds of health care.

Coverage for your mental health treatment is denied because your plan does not consider it “medically necessary.” Your insurance provider must repond to requests asking for the criteria used to reach this decision.

Your plan places all prescriptions used to treat mental health conditions such as depression at a specialty tier, meaning they will cost you more money than if they were considered generic prescriptions.

If you have been denied coverage for mental health care needs such as prescription drugs, co-pays, and partial hospitalization, a number of active steps may be available to you. Additional information and resources that may be helpful are listed in the next section of this page.

Here are some signs your health plan may be violating parity laws:

You have difficulty finding mental health providers or psychiatrists within your insurance plan network.

Higher costs or fewer visits for mental health services than for other kinds of health care.

Test your knowledge

If your insurance company refuses to pay for mental health care, the decision is final.

Correct!

If you are facing a situation where your insurance company is refusing to pay for treatment, there are a number of active steps you can take and options that may be available to you. Check out the resources below.